My career started out as a government optometrist. I idolized private practice optometry and demonized commercial practice. I did this so much that I forsook my excellent career in the Indian Health Service, hired a practice consultant, and started my own private practice. Of course, I had to work commercial to make ends meet while I built the practice. The only problem is that becomes a catch-22. I had to work four days a week at Wal-Mart to afford what became my hobby practice two days a week. I couldn’t work enough in my private practice to build it, but if I didn’t work enough in the commercial practice, then I couldn’t pay the bills for the private practice to stay open.
Now the private practice has miserably and utterly failed. There is no return from paying back the practice loan or the remaining months on the lease, but at least the commercial practice easily covers these expenses. I have closed down Summit Vision Center and now I will focus all my energy into VisionHealth EyeCare.
This blog will now take a new direction. I will be advocating commercial practice, demonizing private practice, and waxing nostalgic of government practice (but not idolizing it since I’m a conservative republican that doesn’t believe in big government).
My big beef with commercial used to be that they provided substandard care. Well, the truth is that individual doctors were providing substandard care. Not detecting or treating glaucoma and not having a TPA license to treat medical eye conditions is simply substandard care regardless of where one practices. I’ve seen private practice optometrists who didn’t even have a BIO.
In future posts I intend to show how independent, commercial practice (and in particular Wal-Mart) is the best modality for optometrists. I’ll show you how I create quality care in my practice, and along the way you will see how my practice evolves to become even better.
So subscribe to the site feed and enjoy the ride.
Corporate Locations Encourage Poor Optometric Care
First off, I’ve worked corporate and now I own my own practice. Second, I’m not talking about any individual OD, just the corporate environment here.
In my experience, the corporate environment provides consistent incentives to provide poor care. This, over time, tears down ODs, instead of building them up. Here is how:
1. Low expectations. People know they are going to Walmart for eyecare.
2. Reduced long-term relationships with patients.
3. Limited space to for staff and equipment.
4. Inability to control optical staff to undercut or contradict what you say.
5. Interference from the optical manager who may repeatedly ask you to do things you are not comfortable with.
6. Expectations of a packed schedule and pressure to always, always, accept walk-ins.
7. Financial incentive to accept the packed schedule and cut corners.
8. Tremendous difficulty providing speciality services such as low vision, vision therapy, and specialty contacts that the corporate entity won’t carry.
9. Less control of the equipment you have.
10. Less time/need to get your hands on the frames and lenses the you are prescribing.
11. Difficulty branding your practice and service.
12. Reduced interest in local/state/national organized optometry.
There are more. The point is that providing quality care takes effort anywhere and I think that it takes tremendous personal dedication to continue to provide excellent care in an environment where excellent care is not the priority. Why
Yes, there are great corporate OD who are resistant to the corporate environment and crappy private practice ODs who are just bad docs. But if I am wrong about all this, then just as many people should be able to point out how the corporate environment promotes better care than PP by encouraging their ODs to better than private practice ODs. But that just isn’t the case.
You may be bitter that you couldn’t make your private practice succeed, but that doesn’t make Walmart the place that provides the best care for patients.
-Nate
I’ll be interested to hear about your experiences at WalMart. You’re right that in the end it’s the Optometrist that determines the level of care, but the Big Box has some influence on the outcome too.
I don’t think even a true-blue (or is that red?) Republican could really call the IHS “big govt”. Not only is it mandated by treaty agreements, but as you well know it’s seriously underfunded. Regan would be proud.
Now the whole Commission Corps system, THAT is probably a poster child for unnecessary complexity and inefficient management.
Make that *Reagan*.
You might want to check out the ODwire thread “Optoblog: Walmart is the BEST place to practice”
The same variability of patient care exists in both private practice and commerical. It is the onsite OD who governs how patients are cared for. Many times the commercial practice will have newer and more up to date equipment than private practices.
MCC
I’m always interested in ODs who fail in optometry. They imply that private practice is not possible… however, private ODs eventually earn more than commercial ODs. Yes, you have to be available 24/7, work on Saturdays and at least one evening, participate in local service clubs, speak to organizations whenever possible, and wait a few years to “make it big”. You have to be a good actor, and always be up… when at times, thats not where you’re at. In choosing where to practice, you have to realize that you’ll do best where there’s the graetest need. I believe some people are meant to be in private… and some are not. Perhaps those in commercial practice HAVE made the right choice for themselves, but in my heart, I don’t think its the best choice for optometry. Limiting practice to refractions and contact lens fittings and referring all your pathologies demeans our profession. In Ohio we’ve worked hard to get the right to diagnose AND MANAGE most eye disease. To yield this ground because your employer discourages it is a mistake.
Since when does becoming an OD require us to open our own private practices? Different modalities exist for different business and practice styles and personalities. I like having 1 employee, not being on call, work 5 days a week, not having insurance to deal with, getting all my fees paid up front same day of service. I maintain long-term personal & fun relationships with my patients, too, since they keep coming back year after year! And of course I detect sight-threatening problems, all within the requirements given us by the AOA. I have electronic records, a VF machine, digital retinal imaging–all of which impress my patients. Care depends on the doctor’s skills, not the practice setting. We all adhere to the same code of ethics, so private practice docs need to stop pigeonholing retail OD’s (who also have their own private practice, it just happens to be inside a retail establishment) as being inferior! Oh, and federal law mandates that we give patients their rx’s after the exam. I do that with every patient, how many of the private docs do that? Every day pts tell me how they fought with staff to get their rx’s or records from their previous private doc. It disgusts me.